Respiratory variability in panic disorder

Martı́nez, José M.; Kent, Justine; Coplan, Jeremy D.; Browne, Susan T.; Papp, Laszlo A.; Sullivan, Gregory M.; Kleber, Marc; Perepletchikova, Francheska; Fyer, Abby J.; Klein, Donald F.; Gorman, Jack M.

doi:10.1002/da.1072

Cited by 64 publications

(44 citation statements)

References 15 publications

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“…This finding is consistent with previous studies showing strong links between panic and asthma (Carr, 1998;Carr, Lehrer, & Hochron, 1992;Davies, Jackson, & Ramsay, 2001;Feldman, Siddique, Thompson, & Lehrer, 2009), panic and respiratory disease (Abelson, Weg, Nesse, & Curtis, 2001;Gorman, Liebowitz, Fyer, Fyer, & Klein, 1986;Martinez et al, 2001;Papp et al, 1997), and with the previously put forth hypothesis that there is a specific common physiologic vulnerability to both (Klein, 1993). It is interesting to note that both panic (Isensee, Wittchen, Stein, Hofler, & Lieb, 2003) and respiratory disease are strongly tied to cigarette smoking yet the association between panic and respiratory disease persists even after adjusting for smoking (and childhood abuse) suggesting this relationship may operate through some other mechanism.…”

Section: Discussionsupporting

confidence: 93%

Childhood Physical Abuse and Respiratory Disease in the Community: The Role of Mental Health and Cigarette Smoking

Goodwin

Wamboldt

2011

Nicotine & Tobacco Research

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Introduction: Previous studies have found an association between child abuse and respiratory disease in some populations, but the mechanisms remain unknown, and this association has not been examined in a representative community-based sample. The goal of this study was to examine the relationship between childhood physical abuse and the odds of respiratory disease and to investigate the role of depression, anxiety, and pack-years of smoking in this association.Methods: Data were drawn from the Midlife Development in the United States Survey (n = 3,032), a representative sample of adults aged 25-74 years. Multiple logistic regression analyses were used to determine the association between childhood abuse and current respiratory disease (past 12 months) and to examine whether pack-years of smoking, depression, and anxiety disorders mediated the relationship.Results: Individuals who often experienced childhood abuse had a significantly increased odds of respiratory disease (odds ratio [OR] = 1.87 [1.21, 2.90]). The association was attenuated, after adjusting for demographic characteristics and pack-years of smoking, and was no longer significant after adjusting for depression and anxiety disorders. Conclusions:These results are consistent with previous data suggesting a significant association between childhood abuse and respiratory disease and extend existing knowledge by providing initial evidence that demographic differences, depression and anxiety disorders, and lifetime cigarette smoking may mediate this observed relationship. Results require replication with longitudinal data in large community-based samples. Future studies that can explore potential biological mechanisms underlying the observed associations, such as immune factors, are needed next to better understand these relationships.

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Section: Discussionsupporting

confidence: 93%

Childhood Physical Abuse and Respiratory Disease in the Community: The Role of Mental Health and Cigarette Smoking

Goodwin

Wamboldt

2011

Nicotine & Tobacco Research

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“…Several of these patients exhibit chronic hyperventilation. Some previous reports have shown greater respiratory variability in these patients, in the laboratory, outside the laboratory and during sleep as well [1][2][3][4]. Thus, considerable evidence suggests a brain stem respiratory control abnormality in these patients, which has been described as a hypersensitive suffocation alarm system [5].…”

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confidence: 82%

Nonlinear Measures of Respiration: Respiratory Irregularity and Increased Chaos of Respiration in Patients with Panic Disorder

et al. 2002

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Background: Respiratory irregularity has been previously reported in patients with panic disorder using time domain measures. However, the respiratory signal is not entirely linear and a few previous studies used approximate entropy (APEN), a measure of regularity of time series. We have been studying APEN and other nonlinear measures including a measure of chaos, the largest Lyapunov exponent (LLE) of heart rate time series, in some detail. In this study, we used these measures of respiration to compare normal controls (n = 18) and patients with panic disorder (n = 22) in addition to the traditional time domain measures of respiratory rate and tidal volume. Methods: Respiratory signal was obtained by the Respitrace system using a thoracic and an abdominal belt, which was digitized at 500 Hz. Later, the time series were constructed at 4 Hz, as the highest frequency in this signal is limited to 0.5 Hz. We used 256 s of data (1,024 points) during supine and standing postures under normal breathing and controlled breathing at 12 breaths/min. Results: APEN was significantly higher in patients in standing posture during normal as well as controlled breathing (p = 0.002 and 0.02, respectively). LLE was also significantly higher in standing posture during normal breathing (p = 0.009). Similarly, the time domain measures of standard deviations and the coefficient of variation (COV) of tidal volume (TV) were significantly higher in the patient group (p = 0.02 and 0.004, respectively). The frequency of sighs was also higher in the patient group in standing posture (p = 0.02). In standing posture, LLE (p < 0.05) as well as APEN (p < 0.01) contributed significantly toward the separation of the two groups over and beyond the linear measure, i.e. the COV of TV. Conclusion: These findings support the previously described respiratory irregularity in patients with panic disorder and also illustrate the utility of nonlinear measures such as APEN and LLE as additional measures toward a better understanding of the abnormalities of respiratory physiology in similar patient populations as the correlation between LLE, APEN and some of the time domain measures only explained up to 50–60% of the variation.

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“…In these regards, patients with premenstrual dysphoria show striking similarity with patients with panic disorder, a condition also characterized by enhanced respiratory variability (see Martinez et al, 2001) and increased responsiveness to CO 2 (Gorman et al, 1984;Kent et al, 2001;Klein, 1993;Papp et al, 1997). Another similarity between panic disorder and premenstrual dysphoria is that both conditions respond to treatment with serotonin reuptake inhibitors (Boyer, 1995;Den Boer and Westenberg, 1988;Eriksson et al, 1995;Modigh et al, 1992;Perna et al, 2001;Sasson et al, 1999;Steiner et al, 1995;Sundblad et al, 1992;Wikander et al, 1998;Yonkers, 1997), including clomipramine administered at very low dosage (Caillard et al, 1999;Gloger et al, 1989;Sundblad et al, 1993).…”

Section: Introductionmentioning

confidence: 99%

Association Between Estrus Cycle-Related Changes in Respiration and Estrus Cycle-Related Aggression in Outbred Female Wistar Rats

Olsson

Annerbrink

et al. 2002

Neuropsychopharmacol

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Premenstrual dysphoric disorder is characterized by irritability surfacing during the luteal phase of the menstrual cycle, and disappearing shortly after the onset of menstruation. Although the cardinal symptoms of premenstrual dysphoria are different from those of panic disorder, the two conditions share a number of traits indicating that they both may be associated with abnormalities in the regulation of respiration. Both subjects with panic disorder and subjects with premenstrual dysphoria are hence reported to display enhanced respiratory variability, and to experience anxiety when exposed to CO 2 . In the present study, the possible influence of the estrus cycle on respiratory parameters in outbred female rats of the Wistar strain was investigated. Before being tested with respect to respiration, the rats were subdivided into two groups: those displaying estrus cycle-related variation in aggression, as evaluated using the resident intruder paradigm, and those not showing aggression throughout the cycle. Whereas the former group was found to display higher respiratory rate during the diestrus phase than during the proestrus/estrus phase, no cycle-related variation in respiration was observed in animals not showing cycle-related variation in aggression. The results support previous studies indicating that the estrus cycle exerts an influence on respiration, and suggest that rats prone to cycle-related aggression are more sensitive also to the influence of hormonal cyclicity on respiration. The possible bearing of these findings for the aberration in respiration displayed by subjects with premenstrual dysphoria is discussed.

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Respiratory variability in panic disorder

Cited by 64 publications

References 15 publications

Childhood Physical Abuse and Respiratory Disease in the Community: The Role of Mental Health and Cigarette Smoking

Childhood Physical Abuse and Respiratory Disease in the Community: The Role of Mental Health and Cigarette Smoking

Nonlinear Measures of Respiration: Respiratory Irregularity and Increased Chaos of Respiration in Patients with Panic Disorder

Association Between Estrus Cycle-Related Changes in Respiration and Estrus Cycle-Related Aggression in Outbred Female Wistar Rats

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